HomeMy WebLinkAboutBuilding Permit Application All APPLICABLEINFO MUST
TB�BE,COMPLETED FOR APPLICATION TO BE ACCEPTED 7
Date: /�' �� OU� Permit Number: /b )/. 00S7
,� =_ COED
NOV /2 2016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSE® l M,9&VVEMENT LOCATIC7N
r � �,�� ��, �m. ,4w•�,�xr 3��!�..�r.0 ., SA��
Address: gw n1ilt odg Q('• PA 2 Plc•e u- FLA• Jq9 qS-
Legal Description: JAN l9bt,yiG ns f t But I L p-6 "1 4-a-
Property Tax I D#: d,311- bol- 0001 -OW-3 Lot No.
Site Plan Name: �F- Block No.
Project Name: Jq C7 'G�P�1S
Setbacks Front Back: Right Side: Left Side:
DETAIl.E® DE�SCR4PTION OF 1J_I/®RK: � �_ �F
P
-7ys%/t// R I-S
RI
0
C®_NSTRIJCTlON lNF®RMAT�ION: .
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: 3_ Sq. Ft. of First Floor: 3, VV�0
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OW�N`ER/LESSEE: C.OIII RAC I%J5
Name Name: Vt
Address: 1, ��, Slrire�.': .. X10�inac
gS. m 1. - Company ram
City: :.'P1e*rte, State: =` .'Address:T=Q
Zip Code: �� Fax: City:,POI ��. L.hG� State: �-•
Phone No. I 1oZ -q(vS-`s3a�'i Zip Code: Fax:T1,2- 3i6-SSLY
E-Mail: Phone No ` ld2- .3-U-
Fill in fee simple Title Holder on next page(if different E-Mail 5-eat- V�-unAe" a cum-• nt--
from the Owner listed above) State or County License C. L 1 3a(a 9 a0
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sll`PP'1:E11/IEN ', L CONSTRtIJCT'I,®N LffN LAUU IIUFO�R.11/IIA`�TIO(V;
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements . A Notice of Commencement mus a rded and posted on the jobsite
before the ' Inspection. If you ' tend to obtain financing, co ender or an ey before
comme work or cordin you
Notice of Commence
Signatur of ner/Lessee/Contractor as-Agent for Owner ignatu of ntracto.r/License Ider
STATE OF FLORIDA STATE OF FLORIDA .
COUNTY OF MAk4')n COUNTY OF J' )(A"It);
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,:21 day of_ CL+o 6e 20_L�, by this dA day of OG{-o(oe,— 20 (p by
(Name of person acknowledging) (Name of person acknowledging)
(Sig/ature of Notary Publ' -State of Florida) (Signa re of Notary P
uate of Florida)
Personally Known 7OR Produced Identification Personally Known Identification
Type of Identification ype of Identification
Produced 4Pu NotaryPubNcStateofFbrtda roduced
e Carmela Frantantonl .*�"°v ' Nota c
C mission FF 975783 4f, Notary Public State of Florida
Commission No. �� � �misslon FF ommission No. FF giIo Frantantonl
My COmmission FF 975783
dt Expires 05/29/2020
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DATE
RECEIVED
DATE
COMPLETED
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